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KEPERAWATAN PALIATIF “ANALISIS JURNAL TENTANG PENYAKIT KANKER LEUKIMIA MYELOID ACUTE” Dosen Pembimbing : Ibu Wa Ode Rahmadania,S.Kep.,Ns.,M.Kep



OLEH : NAMA



: DWI SUGI PRATIWI



NIM



: P201701060



KELAS



: J2 KEPERAWATAN



PROGRAM STUDI S1 KEPERAWATAN SEKOLAH TINGGI ILMU KESEHATAN MANDALA WALUYA KENDARI 2020



ANALYSIS JOURNAL ABOUT ART THERAPY OF DISEASE CANCER LEUKIMIA MYELOID ACUTE



Judul Artikel



Art Therapy As Support For Children With Leukemia During Painful Procedures



Author



Cinzia Favara-Scacco, PsyD, Art Therapist Andrea Di Cataldo, MD Giuseppina Smirne, PsyD



Nama Jurnal, Tahun Publikasi



Gino Schilir , MD Division of Pediatric Hematology and Oncology, University of Catania, Italy



Penelaah



Neneng Anjarwati



Tanggal Telaah



01 Juli 2020



Gambaran Umum



Introduction



Children with leukemia undergo painful procedures such as lumbar puncture and bone marrow aspiration. To overcome pain, certain units offer total anesthesia; others offer generic support; others offer no preparation at all. Since September 1997 we provided leukemic children with Art Therapy (AT), a non-verbal and creative modality that develops coping skills. Our goal is to prevent anxiety and fear during painful intervention as well as prolonged emotional distress.



Method



A methodological split was adopted to make the clinical dialogue age-



appropriate. For children aged 2–5 years, the psychologist systematically introduced a “third object”, an attractive toy such as a puppet, to promote in the child, through a direct association with the toy, a perception of the art therapist as a playful, “safe” person. After the specific questions, the puppet was used as the input to make up a fantasy-projective story. We treated 32 children aged 2-14 years. The modes of AT before, during and after the punctures were as follows: clinical dialogue to calm children and help them cope with painful procedures; visual imagination to activate alternative thought processes and decrease the attention towards overwhelming reality and raise the peripheral sensitivity-gate; medical play to clarify illness, eliminate doubts, and offer control over threatening reality; structured drawing to contain anxiety by offering a structured, predictable reality (the drawing) that was controllable by children; free drawing to allow children to externalize confusion and fears, and dramatization to help children accept and reconcile themselves to Result



body changes. Children hospitalized before September 1997 exhibited resistance and anxiety during and after painful procedures. By contrast, children provided with AT from the first hospitalization exhibited collaborative behavior. They or their parents asked for AT when the intervention had to be repeated. Parents declared themselves better able to manage the painful procedures when AT was offered.



To evaluate the therapeutic effects of the AT approach during LP or BMA, we compared the behavioral styles of the children who participated in the pilot study, as the experimental group (EG), with children in a control group (CG) (Table IV). We sum the positive behaviors adopted by each child within the EG and the CG when the painful procedures had to be applied. The results expressed a relevant difference between the two groups. The number of positive behaviors adopted by the EG was higher when compared to the ones adopted by the CG. More specifically, we have ascertain that from the CG, children from the youngest age range, 2-5 years, showed no good responders; the following age range, 6-10 years, showed 2 good responders among 8; the oldest age range, 1114 years, showed 1 good responder among 6. From the EG, children in the youngest age range showed 7 good responders among 11; the intermediate age range showed 10 good responders among 14; the oldest age range showed 6 good responders among 7. To better illustrate the results of our pilot study, we Analysis



chose to point out those behaviors recurring with higher frequency Art therapy (AT) is a psychotherapeutic approach that utilizes creativity and symbolization to facilitate adaptability and release the inner unbearable feelings in a gentle way, preventing the accumulation of the inevitable states of anxiety during hospitalization (16-19). Based on an analogical communication, it facilitates



empathy,



understanding,



reassurance



and



psycho-emotional



processing in a non-traumatic mode. It has shown to be very appropriate for the hospital setting (2021). In fact, being broad based and offering many modalities,



AT is extremely flexible and adaptable to children’s different personalities and, therefore, capable of stimulating their different coping skills. AT modalities can be combined to reach the therapeutic goal. Specific AT modalities intensify the activity of the brain’s right side (22-24), stimulating imagination and creativesymbolization, facilitating children’s capacity to concentrate on pleasurable thoughts. This stimulation enables the young patient to relax, to reduce the level of anxiety, which can cause corporeal hypersensitivity (25). AT is efficient in compensating the lack of control experienced by the child during hospitalization, by stimulating decision-making among materials and techniques while increasing their quality of life. Through creativity, the child engages a space of intimacy, he is in charge of playing alternative “roles” rather then just being the patient. This ability protects his future psycho-emotional health and Discussion



allows development of an inner identity to continue. ART support was very helpful for parents as well as children. In our study we confirmed that, prior to any psychotherapeutic support, parents easily enter a state of shock when facing a hematology-oncology unit because, as they report, they have read or heard discouraging stories of related illnesses; they develop a sense of guilt because they lack appropriate information about the etiology of the disease; they have an instinctive tendency to want to do something for their child’s wellbeing; and their frustrations cause anger that is often expressed as inappropriate behavior (3739). We observed three major inappropriate behaviors. Parents can become overprotective, suffocating any initiative from



the child; too compliant, destroying the child’s motivation to plan and develop alternative ways to reach their goals or make plans about the future since everything is controlled in the immediate present; or distant and affectionless, defending against the possibility of absorbing the reality of the illness and its severity. For parents, this last is a form of protection but, for the child, it is a message of non-acceptance, of rejection. In these cases, the art therapist led the parent towards a state of greater self-awareness and became a behavioral example by showing possible ways for the parent to interact with the child in a Introduction



Big Problem



supportive manner. Most of these young patients need to undergo diagnostic and therapeutic interventions that are particularly intrusive, such as lumbar puncture (LP) and bone marrow aspiration (BMA). The delicate issue of protecting the child during these stressful interventions has been faced in different ways in various hematology-oncology departments. Some offer total anesthesia, with its associated risks and expenses in terms of time and money (13-15); others offer generic support; and still others offer no preparation at all. Illness and hospitalization define a moment of crisis for parents as well as their children. Their sense of desperation can reach tremendous height because they feel helpless, useless and, often, guilty. Hospitalization tests the intensity of intimacy between the child and the caregiver. The parent’s emotional state, in terms of strength or weakness, has a great influence on the child’s attitude towards hospitalization and treatment (27,28). Through creativity, parents can



engage in a lively dynamic interaction, as compared to inaction and tormenting passivity, overcoming a sense of anxiety and anger at having no control or power over the child’s wellbeing



Research



Adakah pengaruh dari terapi art pada penurunan nyeri pasien leukimia anak ?



Question



Metodologi



Hipotesis



Adanya pengaruh dari terapi art yang dilakukan pada pasien anak untuk



Populasi



meminimalisisr adanya nyeri pada saat melakukan pengobatan. 32 Pasien Lekimia



Subjek



Besar Sampel



Subjek pada penelitian Berjumlah Sebelas anggota kelompok eksperimen (EG) berusia 2-5 tahun, 14 orang berusia 6-10 tahun  dan 7 orang pasien pasien berusia 11-14 tahun 21 orang kelompok eksperiman dan kelompok kontrol



Cara Pengambilan Dengan menggunakan metode cross sectional dimana sampel di uji dan Sampel



diberikan perlakukan pada saat yang bersamaan.



Pengukuran



Kelompok Subjek eksperimen diberikan perlakuan berupa menggambar,melukis maupun memberikan boneka dengan menggunakan imajinasi virtual,dan disini



Analisis Hasil



seoranganak diliat kemampuannya dalam melakukan terapi art Analisis Data Pada Penelitian Ini Dengan Menggunakan metode therapy art



Karakteristik Subjek



Beberapa dari pasien ada



yang



menolak



serta



ada



menerima



yang perlakuan



dengan menggunakan metode art terapi Hasil Utama Hasil menyatakan perbedaan yang relevan antara kedua kelompok. Jumlah perilaku positif yang diadopsi oleh EG lebih tinggi jika dibandingkan dengan yang diadopsi oleh pemerintah pusat. Lebih khusus lagi, kami telah memastikan bahwa dari CG, anak-anak dari rentang usia termuda, 2-5 tahun, tidak menunjukkan baik responden yang; rentang usia berikut, 6-10 tahun, menunjukkan 2 responden yang baik di antara 8;usia tertua rentang, 11-14 tahun, menunjukkan 1 responden yang baik di antara 6. Dari EG, anak-anak diusia termuda kisaran menunjukkan 7 responden yang baik di antara 11; rentang usia menengah menunjukkan 10 responden yang baik di antara 14; rentang usia tertua menunjukkan 6 responden yang baik di antara 7. Untuk lebih menggambarkan hasil studi percontohan kami, kami memilih untuk menunjukkan perilaku yang berulang dengan frekuensi yang lebih tinggi. Kami mengamati bahwa dari CG, sebagian besar anak-anak berusia 2-5 tahun dan 6-10 tahun, takut penerapan anestesi lokal bergerak dengan penuh semangat untuk menghindarinya dan mulai menangis terus-menerus berkepanjangan selama dan setelah prosedur yang menyakitkan, memberikan bukti kegigihan rasa takut, amarah, dan kecemasan yang ada di dalam diri. Setelah LP atau BMA, sebagian



Diskusi



Validitas



besar tidak dapat terlibat dalam kegiatan bermain. Kekuatan Penulisan Jurnal Ditulis Secara Kaidah Penulisan Yang Tepat Serta Penyusunannya menggunakan Kelemahan



studi kasus klinis . Jurnal tidak mencantumkan besar jumlah sampel.



Perbandingan Dengan



Tidak Ada



Penelitian Lain Penjelasannya



Tidak Ada



Importancy



( Biological Plausibility) Penting



Applicability



Dapat Diterapkan.